Provider Demographics
NPI:1609065150
Name:JEANETTE E TRUCHSESS PHD PA
Entity Type:Organization
Organization Name:JEANETTE E TRUCHSESS PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:TRUCHSESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-226-4704
Mailing Address - Street 1:348 PRIOR AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5187
Mailing Address - Country:US
Mailing Address - Phone:651-226-4704
Mailing Address - Fax:
Practice Address - Street 1:348 PRIOR AVE N
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5187
Practice Address - Country:US
Practice Address - Phone:651-226-4704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6129933OtherUNITED BEHAVIORAL HEALTH
MN9275525OtherBLUE CROSS